Expert: Claes-Gustaf Nordquist, M.D. - 1/27/2009

Question
QUESTION: An MRI-Core biopsy showed that I have a Complex Sclerosing Lesion (radial scar and adenosis), with Lobular itraepithelial neoplasia (ALH/LCIS), focally asociated with microcalcifications.  Also flat epithelial atypia and the usual type of intraductal hyperplasia.  Can this be a "wait and watch" situation, or do I need to have this lesion removed?  I am reluctant to do anything because I recently had a mastectomy on the other side, which I found out afterwards, wasn't necessary; a lumpectomy would have been sufficient.  Hence my reluctance to do anything with this.

ANSWER: Dear Sandy, to be sure and be able to give you the best available advice I would need to read your FULL pathology report from this your biopsy. So please, if possible write it here. Unfortunately you must copy it by hand - by typing. As soon as I have read it I will respond!


---------- FOLLOW-UP ----------

QUESTION: Dr. Nordquist asked for further information from the pathology report.  Here it is:  FINAL PATHOLOGIC DIAGNOSIS  a.  Breast, right, 9 o' clock, 9-gauge core needle biopsy:  - Complex Sclerosing lesion (radial scar and adenosis).  - Lobular intraepithelial neoplasia (ALH/LCIS), focally associated with microcalcifications, see comment.  - Flat epithelial atypia.  - Intraductal hyperplasia, usual type, see comment.  Comment:  A.  Immunohistochemical stains for 3-cadherin were performed and support the presence of lobular intraepithelial neoplasia (ALH/LCIS).  Stains for p63 (block A3) and CK 7 (alock A1) reveal no evidence of invasion.  Immunohistochemical stain for CK5/14 was performed on Block A1 and reveals a mosaic staining pattern supporting the presence on intraductal  hyperplasia, usual type. Dr. ------ reviewed the case and concurs with this diagnosis.

ANSWER: This SHOULD be removed! But if it is small enough (I have no information of its size) it can probably be done in the form of a lumpectomy followed by radiation therapy. However since this is your second breast cancer (one in each breast) - if I have understood you correctly - your breast cancer risk is probably quite high. So a mastectomy - followed by breast reconstruction on both sides - should at least be considered.


---------- FOLLOW-UP ----------

QUESTION: Thanks for your prompt reply.  My Complex Sclerosing Lesion measures 0.8 x 0.9 x 0.8 cm.  Is there any possibility that it would go away or shrink since I have been on Arimidex for the past 4 months?  Also, I have been told that LCIS is only a "marker" for cancer; therefore, why do you suggest having radiation after the lesion is removed, when there isn't invasive cancer in the breast?  I was told, in September, that I could "wait and watch" this to see if it changed, and that's what I've been doing.  But it's been 4 months, and that's why I'm asking your opinion.  I don't want an unnecessary surgery; yet I don't want to end up with cancer either.  Thanks for your help with this...

Answer
Yes that is small enough for a lumpectomy if that is what is planned. I do not think you can hope for it to shrink away and disappear, even with Arimidex therapy. LCIS is in my textbooks a cancer in situ or in other terms a cancer stage 0! So it IS indeed a cancer it has just not started to invade its surroundings - yet! But that is just a matter of time! So it is NOT just a marker! It should be removed!  Post surgical radiation therapy is recognized and accepted all over the world based on experience as a complement to lumpectomies in order to decrease the risks of a local relapse or a local new tumor. My advice would have been from the start to have it removed! If a mastectomy is done however, any radiation therapy would probably not be needed. Good luck whatever you do!